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Department of the Treasury - Internal Revenue Service
Form 668 MW
(Rev. February 2004) Notice of Federal Tax Lien
Ar Serial Number For Optional Use by Recording Office
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SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 791410111
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As provided by section 6321, 6322, and 6323 of the Internal Revenue I - y9y?
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore,
there is a lien in favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. c r
Name of Taxpayer TIMOTHY CLARK ° ---?
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Residence 9 SAND PINE COURT ? ,
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MECHANICSBURG, PA 17050-0000
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, zo o?
unless notice of the lien is refiled by the date given in column (e), this notice shall, PG(. / }-
on the day following such date, operate as a certificate of release as defined --1
in IRC 6325(a). ?jf-Jt o? (? OS?? '"
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f
6672 09/30/2009 XXX-XX-5346 05/02/2011 06/01/2021 21552.70
6672 12/31/2009 XXX-XX-5346 05/02/2011 06/01/2021 61157.03
6672 03/31/2010 XXX-XX-5346 05/02/2011 06/01/2021 65143.53
6672 06/30/2010 XXX-XX-5346 05/02/2011 06/01/2021 61676.20
6672 09/30/2010 XXX-XX-5346 05/02/2011 06/01/2021 51572.91
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 261102.37
This notice was prepared and signed at
the 07th day of June
DETROIT, MI
2011
on this,
Signature Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office CAT. 668( (Rev. 2 20041
CAT. NO 60025X